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Revision of primary total hip arthroplasty for peri-prosthetic fracture: A prospective epidemiological study of 249 consecutive cases in France - 26/09/14

Doi : 10.1016/j.otsr.2014.03.030 
M. Ehlinger a, , C. Delaunay b, M. Karoubi c, F. Bonnomet a, N. Ramdane d, M. Hamadouche c

Société française de chirurgie orthopédique et traumatologique (SoFCOT)e

a Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France 
b Clinique de l’Yvette, 67-69, route de Corbeil, 91160 Longjumeau, France 
c Service de chirurgie orthopédique, centre hospitalo-universitaire Cochin-Port-Royal, 75014 Paris cedex 14, France 
d Unité de biostatistiques, pôle de santé publique, CHRU de Lille, 59037 Lille, France 
e SoFCOT, 56, rue Boissonade, 75014 Paris, France 

Corresponding author. Tel.: +33 388 127 719; fax: +33 388 127 713.

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Abstract

Background

Revision total hip arthroplasty (reTHA) for peri-prosthetic fracture (PPF) is increasingly performed but still ranks fourth among reasons for reTHA in registries. In France, no specific registry is available and the frequency of PPF among reasons for THA revision is therefore unknown. Here, our objectives were to determine the relative frequency of PPF as a reason for reTHA, to identify patient-related and primary-THA-related factors associated with reTHA for PPF, to describe reTHA modalities for PPF, and to determine the morbidity and mortality associated with reTHA for PPF.

Hypothesis

PPF is the second most common reason for reTHA, after loosening.

Methods

Consecutive reTHA procedures performed in 30 French centres over a 2-year period were collected prospectively. Repeat revisions and revisions of hemi-arthroplasties were excluded. The epidemiological, clinical, and surgical data needed to answer the questions of the study were collected.

Results

PPF was the second leading reason for reTHA (249/2107, 11.8%). Vancouver type B2 fractures were the most common (n=127 [51.5%]). Compared to patients who underwent reTHA for reasons other than PPF, those with reTHA for PPF were older at primary THA (67.9years versus 57.7years) and more often had intra-operative complications (16.9% versus 11.6%); furthermore, the primary THA was more often cementless (62.7% versus 42.7%) with a dual-mobility cup (20.6% versus 11.1%). At reTHA, the patients with PPF were older (77.6years versus 69.2years), had worst medical condition (mean ASA score, 2.4 versus 2.1) and less physically active (mean Devane score, 2.1 versus 2.4). The patients with reTHA for PPF had a shorter time to revision (9.8years versus 11.4years), a longer operative time (144minutes versus 128minutes), and more frequent use of the posterior approach (77% versus 67%) with a cementless dual-mobility cup (78% versus 60%) and a cementless revision femoral stem (72% versus 50%). Morbidity and mortality rates were high (5.9% operative complication rate and 12% of surgical complications with 4.8% mortality within the first 3months) however, these results were similar to those in the rest of the cohort.

Discussion and conclusion

PPF is the second most common reason for reTHA, a result that is at variance with data in national registries.

Level of evidence

Level IV, prospective observational cohort study.

Le texte complet de cet article est disponible en PDF.

Keywords : Peri-prosthetic fracture, Revision of total hip arthroplasty, Total hip arthroplasty, Orthopaedic registries


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Vol 100 - N° 6

P. 657-662 - octobre 2014 Retour au numéro
Article précédent Article précédent
  • Function and osteoarthritis progression after arthroscopic treatment of femoro-acetabular impingement: A prospective study after a mean follow-up of 4.6 (4.2–5.5) years
  • T. Gicquel, J.-E. Gédouin, N. Krantz, O. May, P. Gicquel, N. Bonin, SoFCOT g
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